United States Government Accountability Office Continues to List Indian Health Service on High-Risk List, One Criterion for Removal from High-Risk List Met

On February 25, 2025, the United States Government Accountability Office (GAO) updated GAO’s “High Risk List” by adding a new area on federal disaster assistance and released the report “Heightened Attention Could Save Billions More an Improve Government Efficiency and Effectiveness.” Importantly, GAO continues to list “Improving Federal Management of Program that Serve Tribes and Their Members” – including the Indian Health Service (IHS)- on the High-Risk List. Specifically, GAO states that IHS has met one criterion for removal from the High-Risk List- “Leadership Commitment”- but the four other criteria- “Capacity,” “Action Plan,” “Monitoring,” and “Demonstrated Progress”- are partially met and still need attention. Progress to meet these criteria will include consistently delivering high-quality health care; drafting a longer-term workplan; improving monitoring; and developing an action plan and related mechanisms to ensure progress on longer-term goals.

GAO states that “[s]enior IHS officials have called for more adequate and stable funding for the agency, including by noting estimates that it is funded at approximately 49 percent of its level of need. IHS officials recently told [GAO] that funding constraints and a lack of staff hampered the agency’s ability to understand and address its facility and medical equipment needs.” The National Council of Urban Indian Health (NCUIH) supports IHS’ National Tribal Budget Formulation Workgroup (NTBFWG) in calling for full funding for IHS to address these issues.

Read the full report here.

About GAO’s High-Risk List

At the start of each new Congress, GAO issues an update to GAO’s High Risk List. The list highlights areas across the federal government with serious vulnerabilities to fraud, waste, abuse, and mismanagement, or in need of transformation. GAO uses five criteria to assess progress in addressing high-risk areas: (1) leadership commitment; (2) agency capacity; (3) an action plan; (4) monitoring efforts; and (5) demonstrated progress. The ratings are based on analysis of actions taken up to the end of the 118^th Congress.

NCUIH will continue to monitor for any developments.